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When is plague not the plague? Doctor finds out

Sunday, Sept. 23, 2012 12:38 PM

Prominent in late August and early Septembers news was the case of plague in a child from Pagosa Springs.

Plague is considered sporadic in the Southwest, with the United States averaging fewer than a dozen occurrences annually. It was also reported that the Pagosa girls illness was the first diagnosed in Colorado since 2006.

From the Latin, plaga, plague meant infection or pestilence. A modern medical dictionary elaborates: Any disease of wide prevalence or of excessive mortality.

In the last, small, U.S. outbreak of (pneumonic) plague in 1919, decades before antibiotics, 12 of 13 afflicted died, including two doctors and a nurse  high mortality for sure.

Pneumonic plague, striking the lungs, is now fortunately rare and occurs person to person by cough and infectious aerosols. Pneumonic plague is the black death that so decimated Europe in the mid-14th century  1348 to 1352  the worst of a number of plagues recorded. Jews became the scapegoats, and even the benignity of the deity was questioned.

The form of plague now with us is bubonic (or glandular) plague. The causative bacterium infects many species of rodents: in the U.S., commonly ground squirrels, rock squirrels, wood rats and prairie dogs. Fleas transmit the infection from rodents with bites to humans and to felines and canines, also. Fleas on dead rodents look for new homes.

A bubo is an infected (with the plague bacterium), swollen, painful lymph node. Lymph nodes are found in the groin (femoral), and neck (cervical) areas of the body. In mononucleosis, all three areas may be swollen and sore, while, with a bad upper-respiratory infection or sore throat, those in the upper neck are affected. Lymph nodes are normally about the shape and size of a lima bean, but a bubo, filled and swollen with pus, may grow to three inches in size. Seventy percent of buboes are found in the groin, as in the girl from Pagosa Springs. Most flea bites Ive seen are top-of-the-socks.

Plague symptoms develop rapidly after the bite  anywhere from two to seven days. Fever and shaking chills are usually followed by a bubo in one to three days. Fifty percent of patients have gastro-intestinal symptoms  abdominal pain, nausea, vomiting and diarrhea. Multi-organ system and blood-clotting failure precede death in days to a week.

I believe most physicians in the Four Corners, especially in ERs, are aware of plague. Certainly the Denver physicians, to whom the Pagosa Springs case was flown, had their eyes wide open. Promptly administered antibiotics were undoubtedly life-saving.

A similar, sick patient arrived in my ER with a swollen, tender lump in the groin  the appearance of an infected lymph node, a bubo, and there was a history of a dead prairie dog in the yard. An ultrasound demonstrated a fluid-filled mass; a needle netted pus-like fluid, sent to the lab. A trio of other doctors concurred: presumptive plague. Antibiotics were started.

However, improvement was marginal and inconsistent. A CT scan demonstrated continuity of the mass with the abdomen  not a bubo but a femoral hernia. Graciously, a surgeon administered the cure.

www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.